Dinah, ClinkShrink, & Roy produce Shrink Rap: a blog by Psychiatrists for Psychiatrists. A place to talk; no one has to listen.
All patient vignettes are confabulated; the psychiatrists, however, are mostly real.
--Topics include psychotherapy, humor, depression, bipolar, anxiety, schizophrenia, medications, ethics, psychopharmacology, forensic and correctional psychiatry, psychology, mental health, chocolate, and emotional support ducks. Don't ask. (It's not Shrink Wrap.)

Tuesday, July 06, 2010

So usually we figure this stuff out by 'evidence-based' research...you know, the whole double-blind, placebo-controlled study using only those perfect research subjects who don't have other problems like substance abuse, pregnancy, childhood, or co-occurring disorders.

This month, Consumer Reports gives their own breakdown of what works for the treatment of depression and anxiety. Here's the Link to their overview. Buy a car, buy a dishwasher, get a shrink...same idea.

Ali writes to us:

Dinah, Roy, ClinkShrink:

The July issue of Consumer Reports includes a survey of more than 1,500 readers about the therapies and drugs that helped their depression, anxiety or both (all those surveyed had sought professional help).

The report provides insight into mental health treatment as it's practiced in the real world, as opposed to the carefully controlled environment of clinical trials. A few of the findings:

- Of readers who sought help for a mental-health difficulty, 58 percent had experienced anxiety, up from 41 percent in our previous mental-health survey, in 2004.

- Rates of reported side effects among people taking antidepressants were higher than those reported in studies funded by drug companies.

- Psychologists (Ph.D.s), social workers (M.S.W.s), and licensed professional counselors (L.P.C.s) received equal helpfulness ratings from those who had talk therapy.

- Respondents to our survey who stuck with talk therapy for just a little while—at least seven sessions—reported as much improvement as those who only took medication (though people who did both fared even better).

I hope you will take a few minutes to read through the results and share the information with your readers.

Let me know if you have any questions.

Best,

Ali

(on behalf of Consumer Reports)

Hmmmmm, so how come they didn't ask if therapy with a psychiatrist works better?

5
comments:

Meg
said...

Read the full article to see the passage quoted below (bolding is mine):

That finding was consistent regardless of whether the person had seen a psychologist, a social worker, or a licensed counselor. Helpfulness scores were somewhat higher for people who had seen a psychiatrist, a medical doctor who can prescribe medication. Of patients who went to psychiatrists, 59 percent received some talk therapy, usually in combination with medication; the rest got only meds. (We also asked people if they had seen psychiatric nurses, practitioners who specialize in mental health and, in some states, can prescribe medications on their own. But only 2 percent of our respondents got their care from nurses, too few to be included in our analysis.) In two states, appropriately trained psychologists have a limited authority to prescribe medications, but in general psychologists typically specialize in talk therapy.

Wow! One part of me thinks... a group devoted to rating TV's and ice cream ought to stay out of medicine. Another part of me thinks : Power to the People! FINALLY some group stepped forward and without taking pharmaceutical money managed to get some numbers... and the numbers show what big liars drug companies really are. The higher rate of side effects reported comes from a group who presumably stayed ON the medication, because I assume the dropouts did not answer a survey designed for takers of a class of drugs.

Psychiatrists as a group, not the individual, have created the situation where people think meds come from psychiatrists and talk therapy comes from psychologists and other less-degreed folks because so many of them have back to back 10-minute appointments during which the doc is looking down writing most of the time.Luckily my own psychiatrist is the talking kind because at least HE is better than the MFCC and psychologist I previously saw. A LOT better.

Most of my psychiatrists, even the ones who have limited the appointments to 15 minutes, try to get in at least a little bit of advice, or advising and counsel, that isn't strictly about the medication. Often the one that tried to limit the appointments to 15 minutes, would end up at 20 to 25 minutes, but he HAD told me in the beginning that if felt like an appointment needed to go longer, he'd let it.

Sometimes he'd get frustrated by it, but it wasn't always me; he went on for 20 minutes once, about how I was keeping HIM; I was thinking, uh, pot calling the kettle black, here? lol.

My other two, have had longer appts. The second one was almost always an hour. My newest one is usually 20-25 minutes. She definitely has intention of doing more than just med management; she definitely wants to get across some type of therapeutic point of view to me, each time we meet, some thing she wants me to learn or some perspective or something. She is very different, and is Buddhist, and is very into mindfulness. I'm not opposed to mindfulness, I'm just not wanting a whole ton of New Agey crap, aside from the benefits that mindfulness can bring. She has really put down cognitive behavioral stuff, though, and I stood up to her when she did, saying that I'd not set aside any tools that worked, not set aside anything I've learned that can help me. I was disappointed when I learned how she viewed that, though. Not that I think CBT is the be all and end all, I have my own views of its shortcomings, which is why I've been resistant to some of it for so long, but recently some of it has been most helpful.

Anyway. I find I really like the combination of a psychiatrist, and my psychologist. I like the one two approach, the two different perspectives, although my new psychiatrist's perspective may be TOO different, I still don't know if she's for me. Maybe it's just because I lucked out and got a really good psychologist, one who is good at making a connection with me, and stuff. I don't trust easy.

OH yeah, my psychiatrist definitely wants to do more than med management; today's appt had more the feel of therapy than a med check; we only spent 5 minutes on meds and 20 on our initially what the heck are you talking about, confusing discussion. I blogged about it (sorry for the long post, I had a sort of funny exchange with some drug reps.